Patient safety driving increased RFID use in hospitals

The University of Vermont Medical Center in Burlington, Vt., announced recently that five million medications have been tracked using radio frequency identification technology.

Adam Buckley, MD, interim chief information officer and chief medical informatics officer at UVMC, said any time a system allows a hospital to track reliably from ordering through dispensing through administration at the bedside, patient safety has been greatly enhanced.

"It's cutting down on medication errors, ensuring that medications are given in a timely fashion, and it's a great way to leverage technology and systems to help address human factor issues," said Buckley.

A vial of the drug Glycopyrrolate with a strength of 1MG/ML became the five-millionth RFID-tagged dose at UVMC tracked by Kit Check, a Washington, D.C.,-based company that makes automated hospital pharmacy kit processing and medication tracking software.

Karen McBride, UVMC's director of pharmacy services, said that patient safety was the main reason for utilizing RFID technology.

"We use a lot of kits in this hospital because our ORs are set up to have individual kits dispensed to the anesthesiologist for each case," she said. "We have hundreds of kits – in addition we have kit-like trays in our code blue carts and on our resuscitation carts."

McBride stressed that when humans are involved, there's always a concern around putting the wrong medication accidentally in a kit and that the RFID kit technology essentially eliminates that possibility.

The way McBride explained it, as the pharmacy receives drugs that are going to be going into these kits – pharmacy technicians put into the software system what the drug is, the quantity, the lot number and the expiration date. Then they print out the RIFD tag from that information and label the drugs with it.

"There's an independent double-check where a second person goes in and puts in the information to help prevent an error and the information that goes in has to match," McBride said.

Mark Neuenschwander, a Bellevue, Wash.-based expert and consultant on bar code-enabled medication dispensing, preparation and administration, said KitCheck "has succeeded out of the gate" by applying RFID tags to anesthesia kits, already operational in over 100 hospitals.

Neuenschwander noted that in the past RFID companies thought at a universal rather than a macro level, but that's changing.

For example, MEPS Real-Time Inc. a company that offers a suite of Intelliguard RFID Solutions, has shifted its from focus from macro to micro RFID solutions, he said. The company now focuses on what they refer to "critical inventory" used by hospitals – high-cost medications in refrigerators and high-risk drugs in anesthesia kits and trays.

Aethon Inc.'s MedEx tracking software links with its TUG robot that robotically transports items throughout hospitals and also tags and track bullets throughout hospitals' pneumatic transport tubes with RFID.

RFID vs. barcode
Despite the progress RFID has made in the hospital setting, the debate over which technology will sustain over the long hall, RFID or bar code, is ongoing among industry experts.

According to Neuenschwander, each technology has its advantages and disadvantages.

Barcodes, he said, are less expensive data carriers than RFID chips. And RFID chips have higher read-failure rates than bar codes.

"Proximity reads are an advantage when I want to read everything that is in a kit, as opposed to handling and scanning items one by one," said Neuenschwander.

At the bedside, Neuenschwander says, proximity reads may be effective in identifying a patient without disturbing their rest. In other words, they can read the chip through the sheets, for example. However, if two patients are side-by-side and the read range is too generous, two patients will be identified and you cannot know which is which without separating them.

Likewise, he says, when administering medications, a nurse could know via proximity reading that he or she has five medications in his hand, one of which is not due for his patient. According to Neuenschwander, the nurse would then need to move all five items out of the range of read and bring them back into the range one by one to know which was which. "This would be terribly inefficient," said Neuenschwander.

Some industry experts have posed the question: Why RFID hasn't been applied to drug packaging for point-of-care verification scanning?

Neuenschwander said that he doubts if RFID chips will ever displace barcodes on drug packages any more than on cereal boxes in grocery stores. Rather, he contends that RFID will augment printed codes on a select number of items.

"A universal shift from bar codes to chips seems as likely to me as the US converting to the metric system," said Neuenschwander. "The US has converted to metric selectively: grams/ kilograms and liters/milliliters in pharmacy, for example. But miles, feet and inches, pints, quarts, and gallons, as well as ounces, pounds, and tons are going to be with us for a long time."

After two decades of talk, however, RFID is more than just a mirage on the frontier, he said: "RFID has finally materialized beyond prototypes to products that are live in hospitals today," said Neuenschwander.

UVMC's Buckley said that people are going to figure out the best way to leverage RFID technology. "Whether it will be the best way to leverage it or whether the price will be cost-prohibitive I don't know. But I think people are going to continue to push the envelope to see how the chips could be leveraged. I wouldn't be so absolute about what it will and will not be used for."

Going forward, UVMC said that its next step is to talk to KitCheck about leveraging similar RFID technology in the OR setting.

"I think that there are opportunities beyond just how we're using it with KitCheck to continue to enhance the quality of the care that we are delivering to patients," said Buckley.